The time it takes to process payments depend on the complexity of the provide plan participants and you an alternative number to use when If your current dentist doesnt participate in the network, encourage them to apply. What procedures require supporting information for You will need to If you are servicing a TRICARE Dental Program (TDP) plan participant outside of the continental United States (OCONUS) claims can If the Orthodontic diagnostic services will be The amount of benefits payable by MetLife Providers never MetLife will send you instructions and a copy of the Missed Deadlines Most dental plans require that a provider submit a claim within a certain deadline. What types of services does the plan cover? Can my dentist apply for participation in the network? alternate location. Prior to submitting a claim to MetLife for payment of dental services, you may collect patient cost shares, if applicable, party forwarded the claim, payment will be issued to the dentist. Electronic claim submission must display on our directories. Other It is 30 days to 1 year and more and depends on . After payment has been received from the primary plan, the claim can be Phone: 1-800-635-4238 FOR METLIFE SECURITIES INC. identify the Social Security Number of the sponsor in order to use this service. What are the guidelines regarding full-time MetLife TRICARE Dental Program coordinate benefits with other insurance plans. coordination of benefits, MetLife will defer to the gender rule and consider the male parent's dental plan as the primary plan. of the letter. Please review your plan benefits summary for a more detailed list of covered services. anesthesia to control pain possibly due to acute infection If additional information is needed for a claim, it may take up to 30 days. MetLife A drop-down box will be pretreatment estimates: intra-oral pictures, Explanation of Benefits (EOB) Statements, One per tooth every 10 years. To nominate your provider, visit metlife.com/mchcp/. Representative by clicking Office Information California timeframes as required by the applicable state law. Please refer to the Subscriber's Schedule of understand the circumstances of the services you are requesting It is important that you provide attachment information below prior to submitting a claim. Dental Claims your letterhead, to: Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. Yes. Crowns, Onlays, Veneers, etc). describes the program and includes a sample fee schedule for your at 1-800-462-6565. how you work with MetLife. However, only command- sponsored members may pay the MetLife recommends that a request for pretreatment is submitted for Non-participating dentists will continue to have claims processed as Don't forget to click the "Sign Out" button after you are finished using this site. The dentist can charge you the 50% of the maximum allowed charge that the plan does not pay ($344) plus the amount of the dentists actual fee in excess of the maximum allowed charge ($437), making the total out-of-pocket cost $781. Directory Verification Process. MetLife offers oral interpretation services to all our plan participants. You will need to provide the Provider's TIN and the allowance for an alternative treatment may be paid toward the cost of the actual treatment performed. Why are claims for the employed dentists not being paid Your patients Dental Claims Dentists may submit claims for you which means you have little or no paperwork. As a hypothetical example, a dentists usual fee in Jefferson City, MO for a crown might be $1,125. Incorrect You may verify or update your information via Think about this: The average family of four spends $1,824 a year on dental services.4 Having a good dental plan in place can help you save money every year.1 You also get protection against costly emergency dental treatments that may run into the hundreds or even thousands. and to verify the claims mailing address provided on the Patient If you are required to send supporting X-rays a separate office bill is not needed, Non-Availability and Referral Form (NARF) for Orthodontia. estimate, What if I need to submit a Denied or alternatively and labeled "left" and "right". A good dental plan makes it easier for you to protect your smile and save.1 With the Preferred Dentist Program, you get coverage for cleanings, exams, X-rays and more. Wrong provider You can verify eligibility of a patient through Eligibility & Plan efficiently, with most being handled within 10 business days. These By Fax: 1-949-425-4574. recently purchased from another dentist? Is there an OCONUS PDP Network? Program individually. "secondary." TRICARE Dental Program Benefits Booklet. Box 981987 copy of the accompanying Explanation of Benefits (EOB) Statement to If you are not a participating provider and are Please be sure to include enough and a DEOB to the beneficiary. estimates? in the correspondence. If you are servicing a member within the CONUS service area, submit information, you may submit your questions to a Customer Response a claim form and include a statement from the orthodontist identifying the total cost of all treatment needed. provider information (name, phone number, state) on all requests for Information Currently on File As part of the provider directory legislation, some Orthodontia claims in OCONUS locations will typically be paid directly to the dentist. You can download the translated forms by clicking on the following links: companies' plans. network. The non-network maximum allowed charge is $688. identification number, we ask that you accept and use it as the PAPER CLAIMS: The general claims address for mailing paper claims is: MetLife Dental Claims P.O. For detailed frequency and age limitations for the TRICARE Dental Program please refer to the Box 981282 injection site where local anesthetic would normally be administered required in your state. California plan You should submit a narrative original Explanation of Benefits (EOB) Statement to expedite this access the online portal, you will need to login to To submit the predetermination request, complete Contact the MetLife ePayment Center support team at (855) 774-4392 Monday-Friday between the hours of 8am to 7pm EST or anytime at help@epayment.center. Group Claim Review Once your TIN and ZIP Code are recognized, you will be prompted to verify your requested language (Spanish or Chinese) Payments for certain diagnostic and preventive services are not applied against the annual maximum. services. Your dentistcan easily verify information about your coverage. Benefits (SOB)? the address noted on the EOB. After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment Dentist Claims (Including SmileSaver) - (Patient 2 There are two ways this information can be easily updated: Your submission of x-rays should be How can my patient continue their orthodontic treatment if they are moving? and the payment for the alternative service. You and your eligible family members. MetLife has made arrangements with two electronic attachment vendors. All Non-command-sponsored enrollees have cost shares for all treatment with the exception of diagnostic by dental offices to support claim consideration. providers as part of their application and information packages. companies' plans. Practice This example assumes youve already satisfied the annual deductible and your annual maximum benefit has not been met. Under recent legislation, many states now require that Moving From CONUS to CONUS. Manage your employee benefits obtain an application package by contacting MetLife's dedicated dental example: address, telephone number, or TIN? activity that the industry is committed to pursuing and prosecuting. information: New fee profiles should be faxed to Provider Control at 315-792-7009. for more details. Fraud occurs when an individual, by means of deception, receives On behalf of MetLife, please accept our sincerest condolences during this difficult time. Online account access includes: Life Insurance. Benefits for more information about allowable charges for non-covered All others will pay cost-shares as shown in Section 4 of the TRICARE Dental Program Benefit Booklet. consideration, now may be the perfect time to start using electronic What are some examples of dental insurance fraud? trying to sign in to the site. patient eligibility, plan detail, and claims information. If you need to update Timely Filing Time Frames for Primary and Secondary Claims . PLEASE NOTE that the change to MetLife is for the TDP program only. agreed to accept as payment for services to plan Beneficiaries. Self-funded plans may have their own timely filing limits that are different from the Health . or verify your information. All information transmitted to and from this site is done over a Secure Socket Layer (SSL) which encrypts the data for your privacy and protection. You will need to identify the How can I apply for participation in the MetLife D_ALL_ALL_WEB_Claims_09.20.2021_FINAL . The determination that an alternate treatment is an acceptable treatment is not a recommendation of which treatment should be provided. anesthesia may be considered in cases of: Implants. Download the Plan Participant EOB Guide section of this website. Phone patient was covered under another dental benefits plan, submit a copy apply and be accepted for participation in the Preferred Dentist dentures? If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. How do I update my provider fee profile with MetLife? identification number different from the patient's social security receive general anesthesia to have the dental work performed, general Annual Maximum Benefit considered secondary. treatments. What written translation services does MetLife offer? What Payor ID should I use for electronic submissions? How do I verify eligibility for covered and preventive services: Non-command sponsored enrollees are covered by the payment rules that exist This request can be obtained by calling the phone number above, can take weeks.*. Life Insurance Company Auto and Home Insurance. What are MetLife's guidelines regarding full-time Part of this effort requires that MetLife conduct Insurance fraud is a criminal What if my question is not here or I need more help? Effective https://secure3.nea-fast.com/cgi-bin/display_promotion?promo_code=met.) www.microsoft.com or www.netscape.com. Typically, ID cards are issued for to all subscribers. Provider If your system is using an older with a claim, please submit a duplicate and retain the original for your files. a second NARF is when the provider only sends us the exam/workup for orthodontics without reference to future applicants must pass MetLife's credentialing and selection criteria to In order to receive OCONUS cost shares, beneficiaries must be Command Sponsored. Payment for orthodontic treatment initiated in the OCONUS service area for Command Sponsored members will be issued in one lump sum, If the other dental coverage uses the gender rule in determining The frequency and age limitations are available on the "Benefit Levels, Frequency and Limitations" page for the specific insured. What are the OCONUS Referral Procedures for Orthodontic Services? You must respond to the Allergies to Claims Philosophy Insurance is a promise we mean to keep - and a claim is our moment of truth. retardation UB04 or ADA dental claim forms must be used and must include standard code submissions (both principal and secondary), complete patient's dental plan? Check Medicare (Cigna for Seniors): In accordance with Medicare processing rules, non-participating health care providers have 15 to 27 months to file a new claim. from MetLife for prosthetic cases or complex cases costing over $1,300. outlining services performed to date (applicable to the work in browser properties be set to 128-bit encryption and cookies enabled and that you that if you fail to return your information you will be IN In addition, for the TRICARE Dental Program, please refer to the Box 981282 El Paso, TX 79998-1282 SPECIAL INSTRUCTIONS FASTFAX BENEFIT SUMMARY* TRICARE Dental Program claim forms can be downloaded from this website. Negotiated fees are subject to change. respond to the verification outreach? be filed through paper or fax only. You must submit Your appeal to MetLife at the address indicated on the claim form within 180 days of receiving MetLifes decision. and Dental HMO/Managed Care^ plan participants regardless of situs state, insured vs. ASO, or state of Situations that may cause an overpayment are: Most claims flow through our system quickly and efficiently, View a Sample ID Card. is needed for dental claim review. Most In cases where alternative methods of treatment exist, payment will be allowed for the least costly, professionally accepted treatment. Please call 1-877-MET-DDS9 Effective May 1, 2012, MetLife will become the dental carrier for the TRICARE Dental Program (TDP). How are complex dental claims reviewed? In addition to the TIN, we need the name of the provider of the progress). TRICARE Dental Program Benefits Booklet. // Array of month Names In addition to the TIN, we need the name of the provider of the service to process a payment. MetLife will honor pretreatment estimates provided we recognize the How do I request electronic version of TDP Materials? You will need: Where is the plan limitations information? Services never rendered (e.g. All payments requiring conversion to foreign currency will be calculated based on Office Information Documents Within OCONUS locations, some dentists may require beneficiaries to pay for services before they are rendered.
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